Provider Demographics
NPI:1467566752
Name:H. KEITH TREIBER DDS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:H. KEITH TREIBER DDS FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-352-7752
Mailing Address - Street 1:412 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850
Mailing Address - Country:US
Mailing Address - Phone:989-352-7752
Mailing Address - Fax:989-352-8542
Practice Address - Street 1:412 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-0080
Practice Address - Country:US
Practice Address - Phone:989-352-7752
Practice Address - Fax:989-352-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3222648Medicaid